Teens Helping Seniors Sign-Up Form

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Thank you for willing to volunteer with Teens Helping Seniors. Our goal is to provide safe contactless delivery to those in need during this time of crisis. We care about the health of our volunteers as well as those we serve. We have a few questions below for you to answer so we can get an idea of the community you can serve and your interests.

If you have any questions, please contact us at teenshelpingseniors@gmail.com.

Email *

What is your name? *

School and Grade (if adult, please skip)

Best number to reach you *

How did you hear about us? e.g. friend, website, social media (if possible please specify) *

What is your address? (Please include city, zip code, state) *

Communities you can serve

Jobs available: Please rank your choices. We will try our best to give you your first choice, however please note that based on demands, we may have to assign you to other jobs as well. *

First choice

Second choice

Third choice

Fourth choice

Fifth choice

Getting and delivering groceries

Fielding phone calls and emails from seniors

Fielding emails from volunteer sign-ups

Website development

Media outreach

Can you drive? *

Additional questions you may have for us

Pledge: I have not traveled out of the country for the virus' 14-day incubation period, do not have any symptoms of COVID-19 (fever, cough, shortness of breath) and have not come in contact with anybody who has tested positive. I have and am practicing social distancing and other safety measures. I will wear gloves and a face mask while shopping and wipe down bags I am delivering. I accept any risks associated with volunteering in my community, including possible exposure to COVID-19. I will not share deliberately or accidentally any personally identifiable information (PII) obtained during my volunteering through Teens Helping Seniors with any third parties. *

I agree

My parent/guardian agrees for the student to volunteer for the above (if below 18 years)

Required

By checking the box above, you are consenting to providing safe contactless delivery to the seniors and vulnerable population in our community while keeping you safe. *

YYYY

Privacy Agreement: I, the undersigned, do hereby allow the members of the Teens Helping Seniors organization to use the information enclosed within this Google Form (including my name, address, phone number, and other identifying contact information) to help fulfill contactless supply delivery for service users. I give full permission to Teens Helping Seniors to provide this information to users seeking such delivery, if necessary. Further, I waive all rights to legal action or recourse against the members of Teens Helping Seniors in regards to the usage of my identifying contact information for the purpose of ensuring contactless supply delivery to users. By signing this document, I hereby affirm that I have read and agree to the Teens Helping Seniors Volunteer Privacy Policy to be found at https://tinyurl.com/volunteerprivacy. *

I agree.

My parent/guardian agrees to the conditions outlined above (if below 18 years).

Please type your signature below. *

Send me a copy of my responses.

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